ICU重症感染老年患者抗感染治疗前后痰细菌培养结果动态变化探讨

Discussion on the Dynamic Changes of Sputum Bacterial Culture Results before and after Anti-infection Treatment in Elderly Patients with Severe Infection in ICU

目的评价抗感染治疗前后痰细菌培养动态结果变化分析对于ICU重症感染老年患者的效果。方法选择该院2018年1月—2019年4月期间收治的ICU重症感染患者76例,所有患者均采用重症下呼吸道或肺部感染患者痰培养结果分析,观察患者抗感染治疗前后痰细菌培养结果动态变化。结果 76例ICU重症感染老年患者痰菌培养阳性率为55.26%,患者患者后第1周、第2周、第3周的痰菌培养阳性率为73.68%、85.53%,97.37%,治疗第4周的痰菌培养阳性率为100.00%。早期痰培养主要以假丝酵母菌属、铜绿假单细胞菌、革兰阳性球菌、肺炎克雷伯菌、嗜麦芽寡养单胞菌。后期中常见为铜绿假单细胞菌、嗜麦芽寡养单胞菌和鲍氏不动杆菌等非发酵菌。在抗感染治疗后,假丝酵母菌属、革兰阳性球菌清除率较高。结论随着重症监护病房住院时间的延长,下呼吸道细菌感染率明显增加,非发酵菌为主要致病菌,为了预防各种因素引起的急性肾功能衰竭,应进一步了解痰培养观察在重症监护病房的重要性。

Objective To evaluate the effect of analysis of the dynamic results of sputum bacterial culture before and after anti-infection treatment on the elderly patients with severe infection in ICU. Methods A total of 76 patients with severe infection in the ICU who were admitted to the hospital from January 2018 to April 2019 were selected. All patients were analyzed by sputum culture results of patients with severe lower respiratory tract or lung infections, and the dynamic changes in sputum bacterial culture results before and after anti-infective treatment of patients was observed. Results The positive rate of sputum culture in 76 elderly patients with severe ICU infection was 55.26%. The positive rate of sputum culture in the first week, second week, and third week after the patients was 73.68%, 85.53%,and 97.37%. The positive rate of sputum culture in four weeks was 100.00%. Early sputum culture mainly used Candida, Pseudomonas aeruginosa, Gram-positive cocci, Klebsiella pneumoniae, and Stenotrophomonas maltophilia. In the later stage, non-fermenting bacteria such as Pseudomonas aeruginosa, Stenotrophomonas maltophilia and Acinetobacter baumannii are common. After anti-infective treatment, the clearance rate of Candida and Gram-positive cocci is higher. Conclusion As the length of stay in the intensive care unit increases, the rate of bacterial infection in the lower respiratory tract has increased significantly, and non-fermenting bacteria are the main pathogenic bacteria.The importance of sputum culture observation in the intensive care unit should be further understood in order to prevent acute renal failure caused by various factors.